HIGHLY VARIABLE GASTRIC-EMPTYING IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Some diabetic patients - particularly those with nausea and vomiting - frequently have evidence of delayed gastric emptying while other diab etic patients may in fact exhibit accelerated gastric emptying. Whethe r the presence or absence of symptoms of upper gastrointestinal dysfun ction correlated with objective measures of gastric emptying in insuli n dependent diabetic subjects was investigated. Twenty one insulin dep endent diabetic patients underwent a solid phase gastric emptying scin tiscan using in vivo labelled chicken liver. Thirteen patients had sym ptoms suggestive of gastrointestinal dysfunction (nausea, vomiting, ea rly satiety, or constipation), while eight patients had no gastrointes tinal symptoms. Eleven patients had orthostatic hypotension. All patie nts had been diabetic since childhood or adolescence. As a group, the diabetic patients showed a half time (T-50) of gastric emptying (mean (SD) 150.0 min (163.7) that was not significantly different from that of 12 healthy control subjects (148.1 min (62.4)). Those diabetic pati ents without gastrointestinal symptoms and without orthostatic hypoten sion, however, showed a gastric emptying half time (70.1 min (41.6)) t hat was significantly faster than that of the control subjects. Conver sely, those diabetic patients with nausea, vomiting, and early satiety (or early satiety alone) showed T-50 values that were significantly g reater than those of the diabetic patients without these symptoms. No correlation was found between the T-50 value and the duration of diabe tes, the fasting blood glucose at the time of study, or the respirator y variation in heart rate (E:I ratio). These observations indicate tha t highly variable rates of gastric emptying occur in insulin dependent diabetic patients, and that accelerated gastric emptying may occur in diabetic patients who have no symptoms of gastrointestinal dysfunctio n.